Provider Demographics
NPI:1780768168
Name:MINNIS, DANIEL N (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:N
Last Name:MINNIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 S ROUSE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6629
Mailing Address - Country:US
Mailing Address - Phone:620-231-2871
Mailing Address - Fax:620-231-3550
Practice Address - Street 1:2002 S ROUSE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6629
Practice Address - Country:US
Practice Address - Phone:620-231-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS64861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice